Provider Demographics
NPI:1720411804
Name:SMELSER, RIANNE VICTORIA (LMP)
Entity Type:Individual
Prefix:
First Name:RIANNE
Middle Name:VICTORIA
Last Name:SMELSER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TROSPER RD SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6972
Mailing Address - Country:US
Mailing Address - Phone:350-556-8799
Mailing Address - Fax:
Practice Address - Street 1:915 TROSPER RD SW
Practice Address - Street 2:SUITE 102
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6972
Practice Address - Country:US
Practice Address - Phone:350-556-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60405114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist